PubMed Health⌕ Search

Biomedical subjects

R Boellaard

Publications and source records attributed to R Boellaard.

14 recordsLinked to original sources

Effects of ROI definition and reconstruction method on quantitative outcome and applicability in a response monitoring trial.

PURPOSE: Quantitative measurement of tracer uptake in a tumour can be influenced by a number of factors, including the method of defining regions of interest (ROIs) and the reconstruction parameters used. The main purpose of this study was to determine the effects of different ROI methods on quantitative outcome, using two reconstruction methods and the standard uptake value (SUV) as a simple quantitative measure of FDG uptake. METHODS: Four commonly used methods of ROI definition (manual placement, fixed dimensions, threshold based and maximum pixel value) were used to calculate SUV (SUV([MAN]), SUV15 mm, SUV50, SUV75 and SUVmax, respectively) and to generate "metabolic" tumour volumes. Test-retest reproducibility of SUVs and of "metabolic" tumour volumes and the applicability of ROI methods during chemotherapy were assessed. In addition, SUVs calculated on ordered subsets expectation maximisation (OSEM) and filtered back-projection (FBP) images were compared. RESULTS: ROI definition had a direct effect on quantitative outcome. On average, SUV[MAN), SUV15 mm, SUV50 and SUV75, were respectively 48%, 27%, 34% and 15% lower than SUVmax when calculated on OSEM images. No statistically significant differences were found between SUVs calculated on OSEM and FBP reconstructed images. Highest reproducibility was found for SUV15 mm and SUV[MAN] (ICC 0.95 and 0.94, respectively) and for "metabolic" volumes measured with the manual and 50% threshold ROIs (ICC 0.99 for both). Manual, 75% threshold and maximum pixel ROIs could be used throughout therapy, regardless of changes in tumour uptake or geometry. SUVs showed the same trend in relative change in FDG uptake after chemotherapy, irrespective of the ROI method used. CONCLUSION: The method of ROI definition has a direct influence on quantitative outcome. In terms of simplicity, user-independence, reproducibility and general applicability the threshold-based and fixed dimension methods are the best ROI methods. Threshold methods are in addition relatively independent of changes in size and geometry, however, and may therefore be more suitable for response monitoring purposes.

Adult↗

Optimization of attenuation correction for positron emission tomography studies of thorax and pelvis using count-based transmission scans.

The quality of thorax and pelvis transmission scans and therefore of attenuation correction in PET depends on patient thickness and transmission rod source strength. The purpose of the present study was to assess the feasibility of using count-based transmission scans, thereby guaranteeing more consistent image quality and more precise quantification than with fixed transmission scan duration. First, the relation between noise equivalent counts (NEC) of 10 min calibration transmission scans and rod source activity was determined over a period of 1.5 years. Second, the relation between transmission scan counts and uniform phantom diameter was studied numerically, determining the relative contribution of counts from lines of response passing through the phantom as compared with the total number of counts. Finally, the relation between patient weight and transmission scan duration was determined for 35 patients, who were scanned at the level of thorax or pelvis. After installation of new rod sources, the NEC of transmission scans first increased slightly (5%) with decreasing rod source activity and after 3 months decreased with a rate of 2-3% per month. The numerical simulation showed that the number of transmission scan counts from lines of response passing through the phantom increased with phantom diameter up to 7 cm. For phantoms larger than 7 cm, the number of these counts decreased at approximately the same rate as the total number of transmission scan counts. Patient data confirmed that the total number of transmission scan counts decreased with increasing patient weight with about 0.5% kg(-1). It can be concluded that count-based transmission scans compensate for radioactive decay of the rod sources. With count-based transmission scans, rod sources can be used for up to 1.5 years at the cost of a 50% increased transmission scan duration. For phantoms with diameters of more than 7 cm and for patients scanned at the level of thorax or pelvis, use of count-based transmission scans is feasible and results in statistically more consistent transmission scans as compared with fixed transmission scan duration.

Algorithms↗

Use of an in-field-of-view shield to improve count rate performance of the single crystal layer high-resolution research tomograph PET scanner for small animal brain scans.

The count rate performance of the single LSO crystal layer high-resolution research tomograph (HRRT-S) PET scanner is limited by the processing speed of its electronics. Therefore, the feasibility of using an in-field-of-view (in-FOV) shield to improve the noise equivalent count rates (NECR) for small animal brain studies was investigated. The in-FOV shield consists of a lead tube of 12 cm length, 6 cm inner diameter and 9 mm wall thickness. It is large enough to shield the activity in the body of a rat or mouse. First, the effect of this shield on NECR was studied. Secondly, a number of experiments were performed to assess the effects of the shield on the accuracy of transmission scan data and, next, on reconstructed activity distribution in the brain. For activities below 150 MBq NECR improved only by 5-10%. For higher activities NECR maxima of 1.2E4 cps at 200 MBq and 2.2E4 cps at 370 MBq were found without and with shield, respectively. Listmode data taken without shield, however, were corrupted for activities above 75 MBq due to data overrun problems (time tag losses) of the electronics. When the shield was used data overrun was avoided up to activities of 150 MBq. For the unshielded part of the phantom, transmission scan data were the same with and without shield. The estimated scatter contribution was approximately 8.5% without and 5.5% with shield. Reconstructed emission data showed a difference up to 5% in the unshielded part of the phantom at 5 mm or more from the edge of the shielding. Of this 5% about 3% results from the difference in the uncorrected scatter contribution. In conclusion, an in-FOV shield can be used successfully in an HRRT PET scanner to improve NECR and accuracy of small animal brain studies. The latter is especially important when high activities are required for tracers with low brain uptake or when multiple animals are scanned simultaneously.

Animals↗

Characterization of a single LSO crystal layer high resolution research tomograph.

The purpose of this study was to determine the performance of a single lutetium oxy-orthosilicate (LSO) crystal layer High Resolution Research Tomograph (HRRT) positron emission tomography (PET) scanner. The HRRT is a high resolution PET scanner designed for human brain and small animal imaging. The scanner consists of eight panel detectors, which have one layer of 2.1 x 2.1 x 7.5 mm thick LSO crystals. Several phantom studies were performed to determine scanner characteristics, such as resolution, scatter fraction, count rate and noise equivalent count rates (NECR). NECR curves were measured according to both NEMA NU2-1994 and NU2-2001 for three different energy windows, i.e. lower level discriminators (lld) of 350, 400 and 450 keV and an upper level discriminator (uld) of 650 keV. Accuracy of scatter and single photon attenuation corrections was evaluated according to NU2-1994. Data were acquired using a ring difference of 67 and a span of 9. Reconstructions were performed using FORE + 2D FBP or OSEM. Transaxial resolution varied from 2.7 to 2.9 mm FWHM between I and 10 cm off centre locations, and axial resolution varied from 3.2 to 4.4 mm FWHM. Scatter fractions (NU2-1994) equalled 0.31, 0.42 and 0.54 for lld of 450, 400 and 350 keV, respectively. NECR data were highest for an lid of 400 keV and showed a maximum of 46 kcps at 38 kBq cm(-3). Lower NECR values were observed according to NU2-2001, but were still optimal for an lld of 400 keV. After scatter and attenuation corrections, pixel values within water, air and teflon inserts of the NU2-1994 phantom were 14, 4 and 35% of the background activity, respectively. The single layer LSO HRRT scanner shows excellent spatial resolution, making it suitable for small animal studies. The low count rate performance, due to the small amount of LSO, prohibits studies of the human brain, but is sufficient for studies in small laboratory animals.

Animals↗

(R)- and (S)-[11C]verapamil as PET-tracers for measuring P-glycoprotein function: in vitro and in vivo evaluation.

The mdr1 gene product P-glycoprotein (P-gp) is involved in the bioavailability and pharmacokinetics of various drugs. Racemic [(11)C]verapamil has been used to image P-gp expression in vivo. A racemic tracer, however, is not suitable for quantification. The purpose of the present study was to identify the most appropriate enantiomer of [(11)C]verapamil as a potential PET-tracer for quantifying P-gp function. The two enantiomers, (R)- and (S)-[(11)C]verapamil, were synthesized and studied in vivo. For the in vivo model mdr1a/1b double gene knock-out and wild type mice were used. The in vitro study made use of the LLC-PK1 MDR cell line to examine the P-gp mediated transport of both enantiomers. The biodistribution of (R)- and (S)-[(11)C]verapamil in dKO and WT mice demonstrated no stereoselectivity of verapamil for P-gp in the blood-brain barrier and in the testes. In addition, no significant differences in P-gp transport for both enantiomers were observed in the in vitro experiments. Previous studies have shown that (R)-verapamil is metabolized less in man and that it has lower affinity for calcium channels. Since (R)- and (S)-verapamil have equal transport for P-gp, the (R)-enantiomer seems to be the best and safest candidate as PET-tracer for measuring P-gp function in vivo.

ATP Binding Cassette Transporter, Subfamily B, Mem↗

Characteristics of a new fully programmable blood sampling device for monitoring blood radioactivity during PET.

The first performance tests of a new fully programmable blood sampling device for monitoring blood radioactivity during positron emission tomography (PET) are described. Blood is withdrawn through 1-mm internal diameter tubing using an infusion pump which can be operated at rates varying from 0 to 600 ml/h. Activity in blood is measured by a 6-cm-thick bismuth germanate crystal connected to a photomultiplier tube and multichannel analyser (MCA) which are positioned within 6 cm lead shielding. Positioning of the tubing is an exact and simple procedure. The minimal readout time of the MCA is 1 s. Two independent energy windows can be set. Operation of the pump and MCA is fully controlled by a PC, i.e. sampling time, interval time and pump rate can be varied at any time during the PET scan by user-defined scripts. A number of characteristics of the new system were studied, such as sensitivity, dead time, linearity, effect of background radiation and pump rate as a function of input pressure. In addition, dispersion was measured as a function of pump rate. Finally, first clinical results were compared with manual samples. The sensitivity equalled 0.7 and 0.2 cps/Bq for 511- and 1022-keV 30% energy windows, respectively, and the system dead time was 500 ns. The system remained linear within 2% with activity concentrations up to 2.5 MBq/cc. Short-term reproducibility was better than 3% for a 1-h period. Long-term reproducibility was about 5% (ISD), which was mainly caused by variation in the diameter of the tubing. If the device was positioned in such a way that maximum shielding was directed towards the patient, the effects of background radiation from the patient on the measured activity concentration for clinically relevant conditions was minimal (<3%). Pump rate varied with input pressure, but remained constant for a given pressure. Dispersion constants smaller than 0.14 s(-1) were observed for pump rates higher than 300 ml/h, indicating that the system dispersion is small. Clinical data showed an excellent agreement to within 3% (ISD) between the results obtained with the new system and manual samples. With the continuous blood sampler radioactivity in blood can be measured accurately during the entire course of the PET scan. Furthermore, the system is fully programmable allowing adjustment of all parameters during a single PET scan.

Algorithms↗

Experimental and clinical evaluation of iterative reconstruction (OSEM) in dynamic PET: quantitative characteristics and effects on kinetic modeling.

UNLABELLED: The purpose of this study was to investigate the quantitative properties and effects of ordered-subset expectation maximization (OSEM) on kinetic modeling compared with filtered backprojection (FBP) in dynamic PET studies. Both phantom and patient studies were performed. METHODS: For phantom studies dynamic two-dimensional emission scans with 10-min frames and 20-min scan intervals were acquired over a 14-h period using an HR+ PET scanner. Various phantoms were scanned: 2-, 5-, 10-, and 20-cm-diameter phantoms filled with an 18F solution (300 kBq/mL) and a NEMA phantom filled with an 18F background (40 kBq/mL) and a cold or 11C insert (450 kBq/mL). Transmission (Tx) scans of 5-60 min were acquired. Data were reconstructed using FBP Hanning 0.5 and OSEM with 2-12 iterations and 12 or 24 subsets. Quantitative accuracy and noise characteristics were assessed. For patient studies, five cardiac, three oncologic, and three brain dynamic 18F-FDG scans were used. Five reconstructions were performed: FBP Hanning 0.5, and OSEM 2 x 12 and OSEM 4 x 16 with and without 5-mm full width at half maximum smoothing. Time-activity curves were calculated using volumes of interest. The input function was derived from arterial sampling. Metabolic rate of glucose (MRglu) was calculated with a standard two-tissue compartment model and Patlak analysis. RESULTS: Contribution of Tx noise to the reconstructed image was smaller for OSEM than for FBP. Differences in signal-to-noise ratio between FBP and OSEM depended on number of iterations and phantom size. Bias with OSEM was observed for regions enclosed within a 5- to 10-fold hotter background. For cardiac studies OSEM 2 x 12 and OSEM 4 x 16 resulted in 13% and 21% higher pixel values and 9% and 15% higher MRglu values compared with FBP. Smoothing decreased all these values to 2%. Similar results were found for most tumor studies. For brain studies MRglu of FBP and OSEM 4 x 16 agreed within 2%. Use of OSEM image-derived input functions for cardiac PET studies resulted in a decrease in calculated MRglu of about 15%. CONCLUSION: For most PET studies OSEM has equal quantitative accuracy as FBP. The higher pixel and MRglu values are explained by the better resolution of OSEM. However, OSEM does not provide accurate image-derived input functions for FDG cardiac PET studies because of bias in regions located within a hotter background.

Algorithms↗

Image-derived input functions for determination of MRGlu in cardiac (18)F-FDG PET scans.

UNLABELLED: Image-derived input functions (IDIF) are frequently used in cardiac (18)F-FDG PET studies for determination of the myocardial metabolic rate of glucose (MRGlu). The purpose of this study was to assess which vascular structure is most suited for defining the IDIF, using online arterial blood sampling (AS) as the gold standard. METHODS: In 18 patients with ischemic heart disease, 370 MBq FDG were injected during a hyperinsulinemic euglycemic clamp. Studies were performed with a Siemens/CTI HR+ PET scanner using a dynamic scanning protocol. A fully automated blood-sampling device was used for continuous AS. IDIF were obtained using regions of interest (ROIs) of 3 different sizes defined on the left ventricle (LV), left atrium (LA), ascending aorta (AA), and descending aorta (DA). MRGlu was calculated with all input functions. Ratios between MRGlu obtained with IDIF and AS were calculated for each patient. RESULTS: Time-activity curves from smaller ROIs suffered more from statistical noise with only a modest reduction of spillover effects, which led to more variation in calculated MRGlu. Mean ratios of MRGlu obtained with IDIF and AS were close to 1 when AA and DA (0.97 +/- 0.07 and 1.00 +/- 0.11, respectively) were used to define the input function. However, when LA and LV were used, mean ratios were 0.81 +/- 0.06 and 0.79 +/- 0.08, respectively, reflecting a significant underestimation of MRGlu. The use of AA for defining the input function resulted in the best agreement with AS and the smallest interobserver variation. CONCLUSION: The ascending aorta is the structure of choice for defining IDIF and a large ROI (diameter, approximately 15 mm) should be used to minimize the effects of statistical noise.

Adult↗

New method to obtain the midplane dose using portal in vivo dosimetry.

PURPOSE: The aim of this study was to develop a method to derive the midplane dose [i.e., the two-dimensional (2D) dose distribution in the middle of a patient irradiated with high-energy photon beams] from transmission dose data measured with an electronic portal imaging device (EPID). A prerequisite for this method was that it could be used without additional patient information (i.e., independent of a treatment-planning system). Second, we compared the new method with several existing (conventional) methods that derive the midline dose from entrance and exit dose measurements. METHODS AND MATERIALS: The proposed method first calculates the 2D contribution of the primary and scattered dose component at the exit side of the patient or phantom from the measured transmission dose. Then, a correction is applied for the difference in contribution for both dose components between exit side and midplane, yielding the midplane dose. To test the method, we performed EPID transmission dose measurements and entrance, midplane, and exit dose measurements using an ionization chamber in homogeneous and symmetrical inhomogeneous phantoms. The various methods to derive the midplane dose were also tested for asymmetrical inhomogeneous phantoms applying two opposing fields. A number of combinations of inhomogeneities (air, cork, and aluminum), phantom thicknesses, field sizes, and a few irregularly shaped fields were investigated, while each experiment was performed in 4-, 8-, and 18-MV open and wedged beams. RESULTS: Our new method can be used to assess the midplane dose for most clinical situations within 2% relative to ionization chamber measurements. Similar results were found with other methods. In the presence of large asymmetrical inhomogeneities (e.g., lungs), discrepancies of about 8% have been found (for small field sizes) using our transmission dose method, owing to the absence of lateral electron equilibrium. Applying the other methods, differences between predicted and measured midplane doses were even larger, up to 10%. For large field sizes, the agreement between measured and predicted midplane dose was within 3% using our transmission dose method. CONCLUSIONS: Using our new method, midplane doses were estimated with a similar or higher accuracy compared with existing conventional methods for in vivo dosimetry. The advantage of our new method is that the midplane dose can be determined in the entire (2D) field. With our method, portal in vivo dosimetry is an accurate alternative for conventional in vivo dosimetry.

Humans↗

First clinical tests using a liquid-filled electronic portal imaging device and a convolution model for the verification of the midplane dose.

BACKGROUND AND PURPOSE: Recently, algorithms have been developed to derive the patient dose from portal dose measurements using a liquid-filled electronic portal imaging device. These algorithms have already been validated for several phantom geometries irradiated under clinical conditions. It is the aim of the present study to investigate the applicability of a liquid-filled electronic portal imaging device in combination with these algorithms for two-dimensional midplane dose verification in clinical practice. MEASUREMENTS AND METHODS: Portal dose images were obtained during several patient treatments under routine clinical conditions. Measurements were performed to verify the midplane dose during radiotherapy of larynx cancer with 4 MV beams, breast and lung cancer with 8 MV beams and prostate cancer with both 8 and 18 MV beams. Midplane doses, determined from portal dose measurements and analyzed with our algorithms, were compared with midplane doses calculated with our three-dimensional (3D) treatment planning system (TPS). RESULTS: For the larynx treatment the measured 2D midplane dose agreed within 2.0% with TPS calculations in most parts of the field. Larger differences were found in a small region below the skin due to the absence of electron equilibrium, which is not taken into account in our portal dose analysis. For breast irradiations the measured midplane dose showed a homogeneous distribution in the AP direction in the axial plane, while high dose regions were observed in the cranial and caudal part of the breast. Portal dose measurements and TPS calculations agreed within 2.5% for most of the prostate and lung irradiations. For a few of the prostate and lung treatments larger local differences were found due to differences between the actual patient anatomy and the planning CT data, e.g. as a result of variable gas filling in the rectum and anatomical changes in the lung. CONCLUSIONS: Portal dose measurements with a liquid-filled electronic portal imaging device can be used to determine the 2D midplane dose for various treatment sites in clinical practice. Portal in vivo dosimetry has proven to be important in detecting changes in the patient's anatomy and its influence on the dose delivery. It is concluded that portal dosimetry is an excellent tool for accurate and independent verification of the dose in the entire (2D) midplane during patient treatment. However, a limited number of patients were involved in this study and the results are therefore preliminary. More research is needed to fully assess the clinical value of portal dose measurements.

Algorithms↗

Two-dimensional exit dosimetry using a liquid-filled electronic portal imaging device and a convolution model.

BACKGROUND AND PURPOSE: To determine the accuracy of two-dimensional exit dose measurements with an electronic portal imaging device, EPID, using a convolution model for a variety of clinically relevant situations. MATERIALS AND METHODS: Exit doses were derived from portal dose images, obtained with a liquid-filled EPID at distances of 50 cm or more behind the patient, by using a convolution model. The resulting on- and off-axis exit dose values were first compared with ionization chamber exit dose measurements for homogeneous and inhomogeneous phantoms in open and wedged 4,8 and 18 MV photon beams. The accuracy of the EPID exit dose measurements was then determined for a number of anthropomorphic phantoms (lung and larynx) irradiated under clinical conditions and for a few patients treated in an 8 MV beam. The latter results were compared with in vivo exit dose measurements using diodes. RESULTS: The exit dose can be determined from portal images with an accuracy of 1.2% (1 SD) compared with ionization chamber measurements for open beams and homogeneous phantoms at all tested beam qualities. In the presence of wedges and for inhomogeneous phantoms the average relative accuracy slightly deteriorated to 1.7% (1 SD). For lung phantoms in a 4 MV beam a similar accuracy was obtained after refinement of our convolution model, which requires knowledge of the patient contour. Differences between diode and EPID exit dose measurements for an anthropomorphic lung phantom in an 8 MV beam were 2.5% at most, with an average agreement within 1% (1 SD). For larynx phantoms in a 4 MV beam exit doses obtained with an ionization chamber and EPID agreed within 1.5% (1 SD). Finally, exit doses in a few patients irradiated in an 8 MV beam could be determined with the EPID with an accuracy of 1.1% (1 SD) relative to exit dose measurements using diodes. CONCLUSIONS: Portal images, obtained with our EPID and analyzed with our convolution model, can be used to determine the exit dose distribution with an accuracy of 1.7% (1 SD) for most clinically relevant situations. EPID exit dosimetry is therefore a good alternative for diode dosimetry. The EPID system is a powerful tool in a dosimetric quality control programme during high dose/high precision radiotherapy.

Humans↗

A convolution model to convert transmission dose images to exit dose distributions.

The aim of this study is to develop a model which computes exit dose values from transmission dose data obtained during patient treatment with an electronic portal imaging device (EPID). The proposed model convolves the primary dose distribution, derived from transmission dose distributions at large air gaps, with a scatter kernel to obtain the exit dose. The influence of inhomogeneities on the scatter contribution is taken into account by using a radiological path length model. To determine the parameters of the model, an extensive set of transmission dose measurements was performed behind various phantoms in an 8 MV beam using a liquid-filled EPID. The influence on the transmission dose of field size, phantom thickness, air gap between phantom and detector, and source-phantom distance was investigated. At air gaps larger than 50 cm the distribution of scattered dose is almost flat and its contribution to the total dose is relatively small, thus allowing an accurate separation of the primary and scattered dose by subtraction. Scattered dose distributions for air gaps smaller than 50 cm were obtained by subtracting the primary dose (corrected for divergence) from the measured total transmission dose. The resulting scattered dose distribution behind homogeneous phantoms has a Gaussian shaped profile, which becomes wider with increasing air gap. The relative contribution of scattered dose depends on the phantom thickness and is maximal for a thickness of about 10 cm. Using these results, the parameters of the convolution model (i.e., the shape of the scatter kernel) were determined. With the model the absolute exit dose is predicted with an accuracy of about 2% (1 s.d.) within the entire radiation field for homogeneous phantoms. Inhomogeneities are taken into account by calculating the radiological path length from the measured primary dose, i.e., without using CT data. By using the measured radiological path length the exit dose can be determined for inhomogeneous phantoms with an accuracy of 2.5%. It is concluded that, using our convolution model, EPID measurements at large air gaps can be used to estimate absolute exit doses in an 8 MV beam with an accuracy of 2.5%.

Algorithms↗

Transmission dosimetry with a liquid-filled electronic portal imaging device.

PURPOSE: To assess the accuracy of transmission dose rate measurements for various phantom-detector geometries, performed with an electronic portal imaging device (EPID) and to compare these transmission dose rate values with exit dose rate data. METHODS AND MATERIALS: Transmission dose rate values on the central beam axis and beam profiles were measured with an EPID consisting of a matrix of liquid-filled ionization chambers. These data were compared with transmission and exit dose rate values, obtained using air-filled ionization chambers for a number of field sizes, phantom thickness, and phantom-detector distances. Various homogeneous and inhomogeneous phantoms were applied. RESULTS: The increase in dose rate with field size is larger for the EPID than in air, due to the larger amount of side scatter in the EPID. The difference has been taken into account by a deconvolution of the EPID images. An additional build-up layer on top of the commercial device is needed to reach dose maximum at the liquid ionization chambers for photon beam energies higher than about 4 MV. The transmission off-axis ratios (OAR) determined with the EPID and in air agreed within 2% for all tested cases, after deconvolution of the EPID signal. The agreement between the EPID-and exit-OAR decreased with increasing phantom-detector distance and the presence of inhomogeneities. For a phantom-detector distance of about 10 cm, the EPID- and exit-OARs agree within 2.5%. The difference could be up to 8% for an air inhomogeneity and a phantom-detector distance of 30 cm. CONCLUSIONS: The difference between EPID measurements and measurements in air can be explained by side scatter effects in the EPID and lack of adequate buildup, and can easily be taken into account. The loss of scatter compared with the situation at the exit side of the phantom explains the difference between transmission and exit dose values. At short phantom-detector distances, good agreement exists between transmission and exit dose rate. This implies that at this distance, the EPID can be used for simple comparison with exit dose calculations during patient treatments. At larger distances, more sophisticated conversion methods are required.

Models, Anatomic↗

The dose response relationship of a liquid-filled electronic portal imaging device.

To use a liquid-filled portal imaging device (EPID) for transmission dosimetry, it is necessary to understand its dosimetric properties. Therefore, the relation between the pixel values (i.e., ionization currents) of an electronic portal imaging device and the dose rate measured with an ionization chamber in a mini-phantom was investigated. First, a model was introduced to describe the ionization current of the matrix of liquid-filled ionization chambers for pulsed radiation. With this model the relation between ionization current and dose rate is explained qualitatively. Next, buildup measurements were performed at different photon beam energies to assess the amount of buildup material required to obtain electronic equilibrium in the detector. This additional buildup material significantly decreased the image quality, which can hamper patient setup verification, at only the 25 MV beam. Pixel values were then compared with measurements made with a Farmer-type ionization chamber in a mini-phantom at various dose rates. In addition, the influence of a number of accelerator and EPID settings (photon beam energy, pulse rate frequency, gantry rotation angle, and image acquisition modes) on the pixel value was investigated. Subsequently, the dose response relationships of three commercially obtained EPIDs of the same type were compared. For all types of measurements the relation between ionization current and dose rate is described within 1% (1 SD) by an equation with two terms: one term proportional to the square root of the dose rate and another term linear to the dose rate. For images obtained under a typical clinical situation (applying the "normal" acquisition mode at an 8 MV beam with a pulse rate frequency of 400 Hz at a transmission dose rate of 100 cGy/min) the contribution of the square root and linear term to the EPID signal is 94% and 6%, respectively. The weight factors of both terms depend on the photon beam energy, pulse rate frequency, and image acquisition mode. It is concluded that the EPID is useful for dosimetry purposes with 1% (1 SD) accuracy, but that the dose response relationship has to be determined for each EPID and accelerator setting.

Biophysical Phenomena↗